Prior research suggests Asian individuals may have severe signs of DED but without proportionate symptoms, possibly due to physical variations in ocular anatomy. Photo: Scott G. Hauswirth, OD. Click image to enlarge.

Ocular comfort and visual disturbances from dry eye disease (DED) can greatly impact a person’s quality of life, but discrepancy between signs and symptoms can make assessment and management difficult. In particular, there is a current lack of larger studies assessing severity differences of dry eye by race/ethnicity.

To bridge this gap, researchers who published a paper in Ophthalmology performed a secondary analysis of data from the Dry Eye Assessment and Management (DREAM) study. In this multicenter, randomized, placebo-controlled study, oral omega-3 supplementation was tested for efficacy on 535 DED patients with moderate-to-severe symptoms.

Of all included participants, 74.4% were white, 12.0% were Black and 13.6% were categorized as another race, including 19 Asian individuals, three of American Indian or Alaskan native descent, nine of more than one race and 42 who provided no answer. Hispanics/Latinos accounted for 12.7% of the study population and 87.3% were not Hispanic/Latino.

After examining the data, it was found that treatment for dry eye at baseline was similar across all races, althoughfor a greater proportion of white individuals used punctal plugs. Hispanic/Latino participants were less likely to use artificial tears/gels, cyclosporine drops, warm lid soaks, lid scrubs or baby shampoo, lubricating ointment and punctal plugs.

Using combined data from baseline and six and 12 months with adjustment for age, sex, smoking status and comorbidities, white subjects in DREAM were found to have worse Schirmer test scores, conjunctival staining scores and composite severity score for dry eye signs when compared with Black counterparts. Hispanic/Latino participants had less severe signs than non-Hispanic/Latino participants for tear break-up time, Schirmer test score, corneal staining score and composite severity score of signs.

Generally, the study researchers found that white and non-Hispanic/Latino individuals had more severe signs of dry eye than Black and Hispanic/Latino participants. However, no significant difference was seen between races for dry eye symptoms. This suggests the possibility for discordance between signs and symptoms among minority racial and ethnic groups. The paper’s authors explain that “this discrepancy indicates that Black and Hispanic/Latino individuals experience similar levels of discomfort as white and non-Hispanic patients but exhibit fewer clinical signs of the disease.”

On a practical level, they convey that “clinicians who rely heavily on observable signs may not diagnose DED in these patients despite their significant discomfort.” The investigators add that since Black and Hispanic/Latino individuals received fewer treatments, this may reflect how sign/symptom discordance contributes to undertreatment within minority groups.

In the future, the authors suggest, “further research should aim to understand why underserved populations may experience this discordance and how sign/symptom discordance impacts DED management strategies.”